56 research outputs found
A kortikoszteroidtartalmú szemcseppek alkalmazása gyermekkori allergiás szembetegségek kezelésében = Application of corticosteroid eye drops for allergic eye diseases in children
Absztrakt:
Napjainkban az allergiás megbetegedések száma folyamatosan emelkedik. Az atópiás
betegeknél gyakran jelentkeznek szemet érintő allergiás megbetegedések
(szezonális és perennialis allergiás kötőhártya-gyulladás, vernalis
keratoconjunctivitis, atópiás keratoconjunctivitis, óriás papillás
kötőhártya-gyulladás, kontaktblepharoconjunctivitis). Az allergiás
szembetegségek kezelésében szemcsepp formájában használt gyógyszerek közé
tartoznak az antihisztaminok, a hízósejtmembrán-stabilizálók, a kettős
támadáspontú szerek, az érösszehúzók és a kortikoszteroidok. Egyes esetekben
szisztémásan antihisztaminok is használhatók. A kezelés látszólag egyszerű, a
helytelen terápia azonban – szélsőséges esetben – akár látásvesztéshez is
vezethet. A szemtünetek enyhítésében a kortikoszteroidok kiváló gyógyszernek
számítanak, de használatuk jelentős figyelmet igényel mind a kezelőorvos, mind a
beteg részéről, hiszen súlyos mellékhatásaik vannak. Ezek közül a látást
leginkább veszélyeztető elváltozások a szteroidindukált szürke hályog és a még
súlyosabb szteroidindukált glaukóma. Felnőttek körében e két kórkép jellemzőit,
előfordulási gyakoriságát és kockázati tényezőit részletesen tanulmányozták,
ellenben gyermekek esetében igen kevés irodalmi adat áll rendelkezésünkre a
szteroidszemcsepp mellékhatásaival kapcsolatosan. Az eddigi tanulmányok alapján
gyermekeknél sokkal nagyobb arányban alakulnak ki mellékhatások a
szteroidterápia mellett, mint felnőttek körében. Orv Hetil. 2019; 160(9):
329–337.
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Abstract:
The prevalence of allergic diseases has been increasing recently. Allergy has
various symptoms. Allergic eye diseases (seasonal and perennial allergic
conjunctivitis, vernal keratoconjunctivitis, atopic keratoconjunctivitis, giant
papillary conjunctivitis, contact blepharoconjunctivitis) are common in atopic
patients. Treatment options for allergic conjunctivitis include local and
systemic antihistamines, mast cell stabilizers, dual-action agents,
vasoconstrictors and corticosteroids. Treatment seems easy, but inappropriate
therapy – in extreme cases – can lead to vision loss. Corticosteroid eyedrops
provide effective relief of symptoms, however, their use is limited due to their
severe side effects. Both steroid-induced cataract and steroid-induced glaucoma
are dangerous for vision. The characteristics, frequency and risks of these side
effects have been studied widely in adults, but there are very few studies
focused on children. According to the present studies, the side effects of
topically administered corticosteroids appear more often in children than in
adults. Orv Hetil. 2019; 160(9): 329–337
A comparison of macular structure imaged by optical coherence tomography in preterm and full-term children
PURPOSE: Macular anatomic abnormalities were examined by optical coherence
tomography (OCT) imaging in premature children and compared with those of
full-term children. METHODS: In a prospective case-control study, premature
patients 7 to 14 years of age were divided into three groups (group I,
laser-treated retinopathy of prematurity [ROP]; group II, spontaneously regressed
ROP; group III, no ROP), and age-matched children (group IV). All the eligible 74
eyes had normal-appearing posterior pole, myopia < or =3 D, and best corrected
visual acuity 1.0. When both eyes of a subject were eligible for the study, one
eye was randomly selected (10 eyes of 10 children in each group). Retinal
thicknesses of the macula measured by OCT3 were compared. The correlation between
central foveal thickness and prematurity (gestational age at birth < or = 30
weeks; birth weight < or = 1250 g) or ROP was determined. RESULTS: The mean
foveal and central retinal thicknesses decreased significantly in group I
(laser-treated ROP) and group IV (term birth). Significant differences in central
retinal thickness were found between the premature groups and full-term children
(Mann-Whitney U test). The cutoff point of central retinal thickness, determined
by receiver operating characteristic curve was 209 microm. The general estimating
equation model statistics found a significant effect of ROP severity (P = 0.003),
P value for the category of prematurity was 0.063. CONCLUSIONS: The central
retinal thickness was significantly higher in the preterm groups than in the
full-term group. This subtle macular modification may be related mainly to ROP.
Prematurity had only a marginally significant role
Rosuvastatin improves impaired endothelial function, lowers high sensitivity C-reactive protein, complement and immuncomplex production in patients with systemic sclerosis: a prospective case-series study
Co-Administration of Proton Pump Inhibitors May Negatively Affect the Outcome in Inflammatory Bowel Disease Treated with Vedolizumab
Concomitant medications may alter the effect of biological therapy in inflammatory bowel disease. The aim was to investigate the effect of proton pump inhibitors on remission rates in patients with inflammatory bowel disease treated with the gut-selective vedolizumab. Patients from the Hungarian nationwide, multicenter vedolizumab cohort were selected for post hoc analysis. Primary outcomes were the assessment of clinical response and endoscopic and clinical remission at weeks 14 and 54. Secondary outcomes were the evaluation of the combined effect of concomitant steroid therapy and other factors, such as smoking, on remission. A total of 108 patients were identified with proton pump inhibitor data from 240 patients in the original cohort. Patients on steroids without proton pump inhibitors were more likely to have a clinical response at week 14 than patients on concomitant PPI (95% vs. 67%, p = 0.005). Non-smokers with IBD treated with VDZ were more likely to develop a clinical response at week 14 than smokers, particularly those not receiving PPI compared with patients on co-administered PPI therapy (81% vs. 53%, p = 0.041, and 92% vs. 74%, p = 0.029, respectively). We found that the use of PPIs in patients treated with VDZ may impair the achievement of response in certain subgroups. Unnecessary PPI prescriptions should be avoided
Ustekinumab is associated with superior treatment persistence but not with higher remission rates versus vedolizumab in patients with refractory Crohn’s disease: results from a multicentre cohort study
Real-life efficacy of vedolizumab on endoscopic healing in inflammatory bowel disease - A nationwide Hungarian cohort study
Background: GEMINI trials demonstrated the therapeutic efficacy of vedolizumab (VDZ) in Crohn's disease (CD) and ulcerative colitis (UC).Research design and methods: Aim of this study was to determine the real-life effectiveness of VDZ on endoscopic healing in the Hungarian nationwide cohort of inflammatory bowel disease (IBD) patients based on changes on clinical and endoscopic scores. Every adult IBD patient in the country (121 UC and 83 CD) who completed short-term VDZ therapy were enrolled, of which 72 UC and 52 CD patients could complete the long-term therapy.Results: Rates of endoscopic healing were substantially higher in UC compared with CD patients during short- and long-term therapy (52.9% vs. 21.7%, p<0.0001, and 51.4% vs. 21.2%, p=0.015, respectively). In CD, the rate of endoscopic healing was lower at week 14 compared with week 22 (14.5% vs. 37.0%, p=0.026). Prior anti-TNF-alpha therapy (88.73%) was not associated with a significant decrease in therapeutic response. Average disease duration was significantly lower in CD patients achieving endoscopic healing at week 52 (11.75 vs. 5.27 years, p=0.007).Conclusions: VDZ therapy is an effective therapeutic option in anti-TNF-alpha refractory IBD. However, endoscopic healing rate was substantially lower and showed a significant delay in CD compared with UC
Efficacy and safety of the biosimilar infliximab CT-P13 treatment in inflammatory bowel diseases: a prospective, multicentre, nationwide cohort
Background and Aims:
Biosimilar infliximab CT-P13 is approved for all indications of the originator product in Europe. Prospective data on its efficacy, safety, and immunogenicity in inflammatory bowel diseases are lacking.
Methods:
A prospective, nationwide, multicentre, observational cohort was designed to examine the efficacy, safety, and immunogenicity of CT-P13 infliximab biosimilar in the induction treatment of Crohn’s disease [CD] and ulcerative colitis [UC]. Demographic data were collected and a harmonised monitoring strategy was applied. Early clinical remission, response, and early biochemical response were evaluated at Week 14, steroid-free clinical remission was evaluated at Week 30. Therapeutic drug level was monitored using a conventional enzyme-linked immunosorbent assay.
Results:
In all, 210 consecutive inflammatory bowel disease [126 CD and 84 UC] patients were included in the present cohort. At Week 14, 81.4% of CD and 77.6% of UC patients showed clinical response and 53.6% of CD and 58.6% of UC patients were in clinical remission. Clinical remission rates at Week 14 were significantly higher in CD and UC patients who were infliximab naïve, compared with those with previous exposure to the originator compound [ p < 0.05]. Until Week 30, adverse events were experienced in 17.1% of all patients. Infusion reactions and infectious adverse events occurred in 6.6% and 5.7% of all patients, respectively.
Conclusions:
This prospective multicentre cohort shows that CT-P13 is safe and effective in the induction of clinical remission and response in both CD and UC. Patients with previous infliximab exposure exhibited decreased response rates and were more likely to develop allergic reactions
Prediction of short- and medium-term efficacy of biosimilar infliximab therapy. Do trough levels/antidrug antibody levels or clinical/biochemical markers play a more important role?
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Real-life efficacy of vedolizumab on endoscopic healing in inflammatory bowel disease: a nationwide Hungarian cohort study
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Long term efficacy, safety and immunogenicity of biosimilar infliximab after one year in a prospective nationwide cohort
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